Provider Demographics
NPI:1689655060
Name:SEWING, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SEWING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-647-9444
Mailing Address - Fax:314-647-7317
Practice Address - Street 1:1031 BELLEVUE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1818
Practice Address - Country:US
Practice Address - Phone:314-647-9444
Practice Address - Fax:314-647-7317
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7862306OtherAETNA
MS217738OtherGHP
MO467007OtherHEALTHLINK
MO000000010854OtherESSENCE
MO0106709OtherUHC
MOH40588OtherMERCY
MO150429OtherBCBS
MOH40588OtherMERCY
MOP00141016Medicare PIN
MO467007OtherHEALTHLINK